When it comes to enhancing athletic performance and muscle growth, creatine is one of the most popular dietary supplements amongst athletes. Go into any store that sells sports supplements, and you’ll find hundreds of different types of pills, capsules, and powders marketed to anyone trying to get their strength gains in. There are many types of creatine, the two most common of which are creatine HCl and creatine monohydrate. All these types make it confusing to determine which is right for you. So that’s what I’m here to help with.
What is creatine?
To start, what exactly is creatine? Creatine is a protein building block, or an amino acid derivative, made from the amino acids glycine and arginine. It is made both in the body (endogenous) and found in foods you eat, such as meat and fish (exogenous). Creatine is stored in skeletal muscles and used as an energy source during high-intensity, short-duration exercise (such as weight lifting).
Creatine supplements work by increasing the amount of creatine phosphate in the muscles, which helps to produce more adenosine triphosphate (ATP). ATP is the primary source of energy for muscular contraction. For those of you who remember learning physiology, you might remember the ATP-PCr energy system, and PCr stands for phosphocreatine.
Benefits of Creatine
Enhanced Performance
Creatine is one of the best-studied supplements, with substantial evidence to support its use when combined with resistance training. It works by increasing the amount of creatine phosphate in the muscles, which helps produce more adenosine triphosphate (ATP). And if you remember from high school biology, ATP is is the primary energy source for muscular contraction!
Because of this increase in creatine content in the muscle, performance in short, high-intensity power output bouts, such as sprints or maximal-effort muscle contractions, can be enhanced. On the other hand, there is little data to support changes in maximal muscle strength, force production, or aerobic capacity with supplementation.
Increased Lean Mass
Because of its role in energy production, an increase in creatine in the muscle enables greater ATP (energy) resynthesis, allowing a greater volume of resistance training. Suppose a person is able to do a greater volume of resistance training than they would be able to do without creatine. In that case, we can assume that it would lead to greater skeletal muscle mass if they respond to resistance training (not everyone is lucky enough to be a “responder”).
Brain Health
In the past ten-ish years, research on creatine has shown that it has a neuroprotective benefit, meaning it protects the brain. It likely does this by acting as an antioxidant. It also enhances the brain’s ability to restore ATP/energy during the high energy demand of a brain injury. For these reasons, it is typically given to athletes after a concussion to reduce inflammation in the aftermath of the injury. But it can also be beneficial to give it prior to a concussion for that brain protective benefit. This is especially true in sports where the risk of concussion is higher, like football and rugby.
Combating Mental Fatigue
The most recent research with creatine is one I find most interesting. Studies have started to show that creatine may help reduce brain fog during sleep deprivation. Jet-lagged athletes may benefit from creatine supplementation, which helps maintain cognitive function and neural processing (reaction time!).
Drawbacks of Creatine
There are some purported drawbacks to creatine supplementation.
Weight Gain
The first is a possible increase in body weight. Some studies show an increased mass in both males and females, trained and untrained individuals, when on creatine supplementation. Creatine increases cell osmotic pressure, leading to cell swelling, represented by increased muscle thickness and mass. This is a fancy way of saying that the cells retain water, get bloated, and are thicc-er. This water retention of the cells may be the weight gain athletes see initially. However, as we noted earlier, creatine improves training capacity, which may increase muscle size over time.
Weight gain on creatine may be about two to five pounds over twelve weeks during a loading phase of creatine, in addition to resistance training. Weight gain is highly variable, depending on the individual’s response. Some people may put muscle on quickly, and some may not. And still more studies have not shown an increase in weight.
Dehydration
Creatine also has a reputation for causing dehydration and being dangerous to kidney health. While these are very real possibilities, taking the recommended dosage and drinking adequate water should allow a person to safely supplement with creatine. Remember that water is being pulled into the muscle cells, making them bloated. With a creatine supplement, you may feel thirstier and need to drink more water than usual. If you already take any medication that increases your risk of dehydration, you are at a higher risk of dehydration. You may need to work with an RD to determine an appropriate creatine dose and hydration strategy.
Gastrointestinal Distress
Finally, it is often reported that additional side effects of creatine supplementation include gastrointestinal distress or muscle cramping. However, most research has refuted these claims. Researchers found the incidence of cramping in football players practicing in the heat while taking creatine was similar to the football players not taking creatine. Similarly designed studies have found the same results: that creatine supplementation does not cause a significant increase in gastrointestinal issues or muscle cramping.
Creatine HCL
Now that we know what creatine can do, let’s compare the different types of creatine products available. The two most commonly seen supplement forms are creatine hydrochloride and creatine monohydrate.
Creatine HCl, or creatine hydrochloride, is one of the newer forms of creatine. Researchers claim that the creatine molecule binds to hydrochloric acid, increasing its water solubility and bioavailability. If these claims are valid, it would mean that creatine HCl can enter the muscle more easily, with less water required to dissolve it, resulting in faster absorption than previous forms of creatine. Finally, HCl proponents claim that HCl supplementation allows a lower dose to increase creatine stores because it is better absorbed.
Unfortunately, HCl is a newer form and has not been as widely studied as creatine monohydrate. The research to date has yet to show that HCl is absorbed as effectively as creatine monohydrate or that it promotes greater muscle creatine retention.
Creatine Monohydrate
Creatine monohydrate is the most common form of creatine and the most extensively studied. It is the gold standard for nearly all research on creatine and is highly bioavailable, safe, effective, and low-cost. It is a combination of a creatine molecule and a water molecule, and when crystallized, it forms a powder containing 87.9% creatine. This powder has been shown to increase creatine levels in muscle cells.
The consensus of the ACSM, AND, Dietitians of Canada, and ISSN is that creatine monohydrate is the most effective ergogenic nutritional supplement available. Creatine has applications in reducing muscle damage after intense exercise, improving outcomes in post-concussion recovery, and preventing age-related muscle loss.
Creatine HCl vs Monohydrate
While creatine HCl is highly marketed, more research is needed on its efficacy. Only two small studies by the same lab have found exercise performance improvements with both creatine HCl and creatine monohydrate. Those same studies found that only creatine HCl led to changes in body composition, specifically lean body mass, with a significant difference between doses. A recent review published in Nutrients concluded that there are no peer-reviewed studies favoring HCl. In it they state, “there is no evidence that Cr-HCl is absorbed more effectively than CrM [creatine monohydrate] in humans[…] or, that lower doses of Cr-HCl are as effective as standard supplementation protocols with CrM.”
A third study done by a different lab did not show better results for exercise performance in HCl versus monohydrate. A recent review did not draw conclusive evidence of the efficacy of any type of creatine compared to creatine monohydrate.
While more research is needed, creatine HCl has yet to be shown to be better, safer, or more effective than the monohydrate form in improving athletic performance or muscle growth. According to the International Society of Sports Nutrition, creatine monohydrate remains the “most extensively studied and clinically effective form of creatine.”
In addition to not having the scientific background of monohydrate, creatine HCl is often more expensive, and there are fewer options for purchasing it.
Creatine Dosage
We know creatine monohydrate is well-studied, and with what we currently know, it is the best absorbed. But how do we actually supplement with it?
When it comes to creatine supplementation, people may use a few different protocols. One standard method starts with a loading phase, where an individual takes a higher dose of creatine, up to 20 grams, for several days to saturate their muscle cells with the creatine molecule. This loading phase may result in some water retention, which can lead to the weight gain we discussed earlier. After the loading phase, a maintenance phase can begin. During the maintenance phase a smaller dose of creatine, about 3-5 grams, is taken to maintain elevated creatine levels in the muscles.
The second method still includes a loading phase, but instead of taking the high dose once a day, the athlete will take smaller doses multiple times a day. This will usually be 5-gram doses, taken 4 times throughout the day. I find this method the most difficult, as it is not very practical for a busy athlete to carry creatine around all day. Do what works for you!
Finally, many athletes may choose to skip a loading phase and take a smaller dose long-term. With this, they will take a small dose, typically 3-5 grams daily.
Creatine Timing
Creatine increases the amount of creatine phosphate in the muscles, which helps produce more adenosine triphosphate (ATP), the primary energy source for muscular contraction. Greater energy in the cell can enable more resistance training. This is why creatine is often called the “one more rep” supplement. It is also why I suggest taking creatine before a workout to maximize its ability to increase lean body mass and improve strength. However, it seems like creatine may be just as effective when taken post-exercise or during exercise. Research has not determined if the timing of creatine is truly important at all. It seems that without more information, the best time to take creatine is when the athlete will take it.
Conclusion
This post is meant to be informative and assist you in finding scientifically sound information on creatine. It is not meant to provide nutritional advice.
Supplementation is multifaceted, and there isn’t a one-size-fits-all approach. Athletes should consult a Sports Dietitian (RD)to determine whether creatine is appropriate for their sport and position. Sports RDs can also assist in determining the correct dose, time, and duration that will be most beneficial for you. They can help athletes monitor how a supplement affects them and adjust over time. If you’d like a customized creatine plan, click here to schedule an appointment with me.
If you are interested in reviewing some of my trusted supplement recommendations, check out my Fullscripts account.
